Patient Family Advisory Council Application

Listening to patients and families is central to Plumas District Hospital’s approach to quality and improvement. The Patient and Family Advisory Council (PFAC) elevates the collective experiences of our community, supporting meaningful engagement in healthcare improvement efforts. In partnership with Plumas District Hospital, the PFAC serves as a key resource, offering insight that helps shape a better care experience for patients and families. Please fill out the application form below to apply.

Patient Family Advisory Council Application

First Name ^*

Last Name ^*

Email Address ^*

Phone ^*

Languages Spoken:^*

Are you willing to share your contact information with other PFAC members? ^*

Yes

I/my family member has been treated at Plumas District hospital on:

I am the: ^*

Parent

Spouse

Caretaker

Patient

Other

Please tell us where you or your family member received care (Check all that apply):^*

Emergency Room

Medical Surgical Unit

Hospital/Swing Bed

Surgery

Outpatient Clinics

Laboratory/Imaging

Other Departments

Please tell us about any other care you received

Please tell us the activities you might be interested in: ^*

Improving the healthcare experience

Improving Patient Safety

Other projects/Interests (please explain below)

Other projects/Interests: ^*

Please tell us why you are interested in joining the Patient and Family Advisory Council:^*

Please describe any other committee experience you have had either in schools, community, places of worship?^*

Do you have experience with public speaking and are you comfortable speaking in front of people?^*

Were there any situations where Plumas District Hospital helped make you or your family member's patient experience more comfortable?

Were there any situations where Plumas District Hospital contributed to you or your family member's patient experience being more difficult?

Please tell us the most convenient time for you to attend meetings?^*

Daytime

Evening

Patient Family Advisory Council Application